The Yale Journal for Humanities in Medicine
When Doctors Get Sick: A Reprise
Ronald Karpick, M.D.
I contracted pulmonary TB during the latter half of my JAR while at Duke. As an illness, it was mild. I had a nagging cough and a little phlegm. I was tired, but what Duke Internal Medicine Resident wasn't! It was serious in that it could have interrupted my education and it did disrupt my social life. Fortunately, I was able to study and even get involved in patient rounds after I had a negative sputum. I set out teaching my fellow patients about the disease and how it affected them personally and their families. It was fun and interesting as these individuals were primarily poor white and black people in North Carolina, whereas I was born and raised in Buffalo, New York, a pretty white place then. The illness did put off my Barry Plan until after I finished my Fellowship. My social life may have gotten better in that I was a little less up tight about life in general. I did not get married until after my Fellowship and after my two years of Naval commitment.
My only other serious problem developed in the fall of 1998. I developed severe pain in my shoulder. Initially, the neurologist to whom I have been going to treat my severe common migraine (one headache every two to three days) initially did not have an answer, nor did the orthopedist I saw (yes, I really made an appointment and saw him in his office). Eventually my motor strength of my right (dominant) arm became weaker, and the EMG verified nerve root irritation. After two MRIs it was determined that a bone spur at C5-6 was the culprit. I saw three different Neurosurgeons and got three different opinions as to what should be done. I chose the one whose opinion was closest to my own, after doing lots of reading and talking. I was an add-on case at the end of the day. What an experience! Fortunately, my wife, a Hospice Nurse, stayed with me. The operation seemed to go well, but I could not go to the fancy private room on the top floor, so I went to a semiprivate room where I was alone. We hardly saw the nurses. They put on Pneumatic Teds, but there was no air compressor to attach to them. My migraine kicked in with a vengeance, not only causing a headache but also severe nausea. The nurse did not want to come to my room or call my surgeon until my wife insisted. My mouth was very sore and whenever I tried to drink I could feel myself aspirate. Visions of permanent nerve damage danced through my groggy head. The post anesthesia nurse came by to check me. She never touched me, only writing on her followup form. I was told that my throat hurt because of the endotracheal tube and it would be better. The surgeon was happy with her work, and the orthopedist was happy with his bone graft, but no one looked at my throat, even though I told everyone about it. When I got home after my 18 hour stay, I looked into my throat and was amazed to see a deep gash in both my hard and soft palate. After I told my surgeons about my finding, I eventually received a call from the Chief of Anesthesia saying that the records did not show any problem with induction or with extubation. I was left to surmise that the gash arose DE novo. When I called the hospital ombudsman to relate my experiences, my calls were not returned. My throat and neck have healed, my strength is coming back with regular exercise. I had to take three weeks off from my practice, primarily due to the pain and difficulty walking from the bone donor site. I went back to work, but there is no such thing as part time, my associates wanted me back on the night and weekend call schedule. Thus with neck brace on, and taking taxi cabs to the office and the hospitals and nursing homes I was back working again. The patients were sympathetic with me. It was heart warming to see them be concerned about me, when they were in the office to get their own illness treated. Each of these illnesses allowed me to see the medical system from the patient perspective, and develop more empathy. I enjoyed the movie The Doctor. More physicians need to be more understanding of what their patients go through.
Tuberculosis only temporarily disabled me. It certainly allowed me an opportunity to do some in-depth reading on the topic. It helped me take better care of patients with the disease. I learned that medication is really important, whereas bed rest and food is not. As long as one takes their medications and are not infectious, they are encouraged to lead normal lives. My choice of a Pulmonary Fellowship was obviously shaped by my own illness. Pulmonary Medicine and subsequently Critical Care has been a very interesting and exciting endeavor.
When I had TB my physician became the TB doctor of the county and the sanitarium. He was a much older man who also had TB in his youth. He treated me like a patient, in that I stood by my door when he was making rounds, he had me get gastric lavages and IM streptomycin. They did not give me a roommate, and after my negative smears, did allow me to sit in with the UNC housestaff on patient rounds. I know I got more from those conferences than did my housestaff counterparts.
When a physician allows me to be their doctor, I try to treat them like every one else. I sit down, take a thorough history and physical exam, and go through a differential diagnosis and plan of diagnosis and treatment. My experience has been that MDs do not like to schedule appointments and be followed as they should. I gently try to tell them that it is in their best interest, and write in my daytimer when I need to call them. I only accept insurance, and do not try to collect from a physician or their family. This may get me into trouble with some insurance commissioner, but so far it hasn't. My advice to other physicians treating other physicians is to treat them as you would like to be treated, but acknowledging that physicians like to do things their way, so you have to keep after them to be sure the correct things are done in a timely manner.
I received a prize for being a compassionate medical student at Yale. I have always been sensitive to other peoples needs. My own illnesses have just made me more resolute to listen to my patients and try to ascertain what their needs are. I may have a goal for them, but they may have a different set of priorities and I have to appreciate that. I do try to ascertain how the illness is affecting them and their families. I do try to learn how they are coping, but I must admit that I could be better. One of my patients committed suicide by shooting himself the morning of a scheduled office visit when I had spoken to him the night before. I had no idea he was planning that end to his terminal emphysema and respiratory failure due to alpha one anti-trypsin deficiency. As with my other patients who die, I will send his family a sympathy card, and will call his wife again in about a month to see how she is doing. I always tell the spouse or children to feel comfortable to call me if they have any questions about anything. I think I have become a better physician from my experiences. I have not become a better Doctor in that I cannot see patients rapidly, I do return phone calls, I do call people with the results of their tests as soon as I get them, I do not make them come in for an appointment to go over the data, I do visit them when they are hospitalized by another physician.
I am still a type A person. My younger associates and colleges do not enjoy my critiques of their work, especially if I think they could do better. However, I see an insidious change occurring. Physicians are commodities, they expect to work from 9-5, they do not have to do anything extra. I want physicians who care, who do ask the right questions and if they do not know an answer, find it, not forget the question. I have not resorted to "Alternative Medicine." I do believe in exercise, rest and a proper diet. I have tried to read Weil's books but find him antiscientific, I wonder what he did at Harvard. I subscribe to Wisneski's The Integrative Medicine Consult, but it gets put to the bottom of my pile of journal reading.
It was helpful to write about my illness. I have felt bad for Dr. Saltzman that I did not chose him as my Duke physician. I have run into him at a number of pulmonary conferences over the years and finally told him that. I was able to send him a copy of the chapter hoping he would understand, and I think he may.
I have always been religious, the illnesses only reinforce my feeling about a supreme being. I feel uncomfortable for individuals who do not believe in a supreme being or in a life hereafter. Their life is so finite.
With regard to my family life, I would like to say it has improved. Unfortunately, I take being a physician much too seriously. I feel that I do make a difference in the lives of my patients, so I do work late at night, making phone calls and dictating notes to fellow MDs. I do make that extra trip to the hospital, even though I could see the x-ray or slide the next day, but one day makes a difference.
I am thinking about retiring from my practice. I do hope my health continues and I will be able to spend more time with my wife and with my adult children. I do hope I can do more gardening and canoeing, but we shall see.
Published: May 8, 2000